Dittrich H C, Blanchard D G, Wheeler K A, McCann H A, Donaghey L B
Adult Cardiac Noninvasive Laboratory, University of California, San Diego.
J Am Soc Echocardiogr. 1990 Jul-Aug;3(4):303-9. doi: 10.1016/s0894-7317(14)80313-1.
Previous studies that have validated Doppler indexes of mitral inflow have used pulsed wave sample volume locations either at the level of the mitral valve anulus or at the tips of the mitral valve leaflets. Although significant differences between absolute values for peak velocities and velocity time integrals at these sample volume locations have previously been reported, no information exists that has compared changes in inflow profiles after an intervention to improve left ventricular filling. To address this question, 13 patients with severe pulmonary hypertension (mean pulmonary artery pressure, 50 +/- 13 mm Hg) caused by chronic thromboembolic disease were studied with use of Doppler echocardiography immediately before and after surgical reduction of pulmonary hypertension (pulmonary vascular resistance decreased from 916 +/- 413 to 233 +/- 89 dynes.sec.cm5). This clinical model has been shown to have abnormal mitral inflow velocity profiles that improve markedly after surgery. Doppler measures of early and late peak velocities were significantly lower both before and after surgery when sampling at the mitral anulus compared with the leaflet tips, although late filling parameters and the deceleration of early flow velocity tended to differ little. With surgery, the significant increase in peak early velocity and the ratio of early to late velocity was present regardless of the sample volume location (peak E at leaflet tips, 47.1 +/- 16.0 to 68.9 +/- 15.4 [p less than 0.001], and at anulus, 40.7 +/- 11.3 to 56.2 +/- 14.6 cm/sec [p less than 0.001]; peak E/A at leaflet tips, 0.95 +/- 0.4 to 1.55 +/- 0.9, and at anulus, 0.78 +/- 0.3 to 1.32 +/- 0.7 [both p less than 0.02]).(ABSTRACT TRUNCATED AT 250 WORDS)
以往验证二尖瓣流入多普勒指标的研究，其脉冲波取样容积位置要么在二尖瓣瓣环水平，要么在二尖瓣叶尖部。尽管此前已有报道称这些取样容积位置处的峰值速度绝对值及速度时间积分存在显著差异，但尚无关于干预改善左心室充盈后流入血流形态变化比较的信息。为解决这一问题，我们对13例由慢性血栓栓塞性疾病导致严重肺动脉高压（平均肺动脉压50±13mmHg）的患者，在肺动脉高压手术减压前后（肺血管阻力从916±413降至233±89达因·秒·厘米⁻⁵）立即进行了多普勒超声心动图研究。该临床模型已显示二尖瓣流入速度形态异常，术后有显著改善。与瓣叶尖部相比，在二尖瓣瓣环处取样时，术前和术后早期及晚期峰值速度的多普勒测量值均显著较低，尽管晚期充盈参数及早期流速减速变化不大。手术治疗后，无论取样容积位置如何，早期峰值速度及早期与晚期速度比值均显著增加（瓣叶尖部E峰峰值从47.1±16.0增至68.9±15.4[p<0.001]，瓣环处从40.7±11.3增至56.2±14.6厘米/秒[p<0.001]；瓣叶尖部E/A峰值从0.95±0.4增至1.55±0.9，瓣环处从0.78±0.3增至1.32±0.7[均p<0.02]）。（摘要截断于250字）
